Dameron Hospital
   

   Effective Date:  April 14, 2003

HIPAA STATEMENT

If you have any questions about this notice, please contact the HIM Department.

WHO WILL FOLLOW THIS NOTICE

This notice describes our hospital's practices and that of:

•  Any health care professional aurhorized to enter information into your hospital chart.

•  All departments and units of the hospital.

•  Any member of a volunteer group we allow to help you while you are in the hospital.

•  All employees, staff and other hospital personnel.


REGARDING MEDICAL INFORMATION

The following notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please review it carefully.

Dameron Hospital Association understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of care and services you receive as a patient at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by the hospital personnel or your personal Doctor. Your personal Doctor may have different policies or notices regarding the Doctor's use and disclosure of your medical information created in the Doctor's Office or Clinic.

This notice will tell you about the ways in which Dameron Hospital may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

Dameron Hospital is required by law to:

•  Make sure that medical information that identifies you is kept private;

•  Give you this notice of our legal duties and privacy practices with respect to medical i    information about you; and

•  Follow the terms of this notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

•  FOR TREATMENT: Dameron may use medical information about you to provide you with medical treatment or services. Medical information may be disclosed to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of your at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Additionally, Dameron may disclose information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care.

•  FOR PAYMENT: Dameron may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party.

•  FOR HEALTH CARE OPERATIONS: Dameron many use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. This information could be used to evaluate our services and the performance of our staff caring for you. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

•  FUNDRAISING ACTIVITIES: We may use information about you, or disclose such iinformation to a foundation related to the hospital to contact you in an effort to raise money for the hospital and its operations.  You have the right to opt out of receiving fundraising communications.  If you receive a fundraising communication, it will tell you how to opt out.

• MARKETING AND SALE: Most uses and disclosures of medical information for marketing purposes, and disclosures that constitute a sale of medical information, require your authorization.

•  HOSPITAL DIRECTORY: Dameron may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. Unless there is a specific written request from you to the contrary, this directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This information is released so your family, friends and clergy can visit you in the hospital and generally know how you are doing.

•  INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE: We may release information about you to a friend or family member who is involved in your medical care or give the information to someone who helps pay for your care. Unless there is a specific written request from you to the contrary, we may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

•  RESEARCH: Under certain circumstances, we may use and disclose medical information about you for research purposes. All research projects, however, are subject to a special approval process. Our Medical Staff Services Department has complete details regarding medical research. Dameron will always ask for your specific authorization if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.

•  AS REQUIRED BY LAW: Dameron will disclose medical information about you when required to do so by federal, state or local law.

•  TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY: Dameron my use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

•  ORGAN AND TISSUE DONATION: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

•  MILITARY AND VETERANS: If you are a member of the armed forces whether United States or foreign, we may release medical information about you as required by military command authorities.

•  WORKERS' COMPENSATION: Dameron may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

•  PUBLIC HEALTH RISKS: Dameron may disclose medical information about you for public health activities. These activities generally include the following:

  • To prevent or control disease, injury or disability;
  • To report births and deaths;
  • To report the abuse or neglect of children, elders and dependent adults;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk    for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. Dameron will only make this disclosure if you agree or when required or authorized by law.
  • To notify emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.

•  HEALTH OVERSIGHT ACTIVITIES: Dameron may disclose medical information to a health oversight agency for activities as required by law. These activities are necessary for the government to monitor health care systems, government programs, and compliance with civil rights laws.

•  LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.

•  LAW ENFORCEMENT: We may release medical information if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the hospital; and,
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

•  CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: Dameron may release medical information to a coroner or medical examiner. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

•  NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES: We may release medical information about you to authorized deferral officials for intelligence, counterintelligence, and other national security activities authorized by law.

•  PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS: We may disclose medical information about you to authorized federal officials so they may provide protection to the president, other authorized persons or foreign heads of state or conduct special investigations.

•  INMATES: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

• MULTIDISCIPLINARY PERSONNEL TEAMS: We may disclose health information to a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child's parents, or elder abuse and neglect.

• SPECIAL CATEGORIES OF INFORMATION: In some circumstances, your health iinformation may be subject to restrictions that may limit or preclude some uses or disclosures described in this notice. For example, there are special restrictions on the use or disclosure of certain categories if information - e.g., tests for HIV or treatment for mental health conditions or alcohol and drug abuse.  Government health benfit programs, such as Medi-Cal, may also limit the disclosure of beneficiary information for purposes unrelated to the program.

 

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

•  RIGHT TO INSPECT AND COPY: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the HIM Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licenses health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

•  RIGHT TO AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital.

To request an amendment, your request must be made in writing and submitted to the HIM Department. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support that request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for the hospital;
  • Is not part of the information which you would be permitted to inspect and copy; or,
  • Is accurate and complete.

•  RIGHT TO ACCOUNTING OF DISCLOSURES: You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you other than our own uses for treatment, payment and health care operations, as those functions are described above.

To request this list or accounting of disclosures, you must submit your request in writing to the HIM Department. Your request must state a time period which may not be longer than six years and may not include dates before April 14th, 2003. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

•  RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

To request restrictions, you must make your request in writing to the HIM Department. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

•  RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the HIM Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

•  RIGHT TO A PAPER COPY OF THIS NOTICE: You have the right to a paper copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

To obtain a paper copy of this notice: Contact the HIM Department.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. A current copy of the notice will be posted in the hospital. The notice will contain the effective date under the title. Additionally, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Privacy Officer at (209) 944-5550. Any complaints are to be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

 



 

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